Radiologists Push for Medical Reports Patients Can Understand

Some Doctors Want to Demystify the Impenetrable Jargon

Imagine reading a medical report about yourself that is clear, concise and respectful of your feelings.

As more patients gain direct access to their electronic health records, some radiologists are leading a push to demystify the medical mumbo jumbo those patients will find there.

Radiologists, who use imaging techniques such as MRIs, ultrasounds and CT scans, play a critical role in the diagnosis and treatment of many diseases. However, their reports traditionally have been treated as private communications with referring physicians, who then share the news with patients. As such, the reports often use jargon that is "perhaps purposefully" opaque to others—and are sloppily written, to boot—according to an open letter in the Journal of the American College of Radiology from a group of radiologists, published online in May and released in print this month.

With many patients now seeing reports at the same time or soon after their doctor does, and a push for more transparency in health care, it's time to brush up on writing skills, enhance patient understanding of imaging results and empower them to take greater roles in health care, according to the letter's authors, who work at Penn State University, Beth Israel Deaconess Medical Center in Boston, Boston Children's Hospital and Harvard Medical School.

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Writing Class

For the past six years,
Michael Bruno
—lead author of the letter and director of quality services and patient safety at the Milton S. Hershey Medical Center at the Penn State College of Medicine—has been conducting report-writing workshops for radiology residents at the Hershey center. The goal is for every resident to attend a workshop once or twice during their four-year training.

Radiology groups have created a growing number of templates that organize reports for easier reading. But Dr. Bruno says there is little training in how to simply write well. Most of his course focuses on emphasizing brevity, simple sentence construction and careful word choice to avoid ambiguity or misunderstanding.

Residents are encouraged not to be unnecessarily wordy. Acronyms are discouraged, as is the use of tortured construction such as "a too-small-to-characterize lesion of the liver" when it would be better to say "Liver: Several lesions that are too small to characterize are likely simple cysts."

Dramatic language such as "epicenter of the mass" can also lead to misunderstanding, Dr. Bruno says, implying a tumor might be spreading from a center like an earthquake, when that might not be the case. And calling a lesion "ill defined" is too vague; if it means the margins are hard to see, the report should say so outright, he says, calling it "poorly marginated."

Lori Mankoswki Gettle, a fourth-year radiology resident who took the class in her first year, says it has helped her focus on improving her writing skills. "I've seen some unclear reports and I could have been on the road to doing that myself," she says. "Once you start writing them a certain way, it is easy to learn some bad habits and perpetuate things you've seen others do."

Dr. Gettle says she also learned how to filter out unnecessary or irrelevant observations. By the same token, the course teaches residents to avoid what it calls "buried treasure," such as mentioning a probable cancer in the middle of a long report, where it might go unnoticed, rather than calling attention to it more clearly.

Sensitivity Training

There is growing recognition of the need to provide patients with information in lay language, and to be careful about using words that may confuse or offend patients. In a 2013 paper, radiologists at Mount Sinai Beth Israel, a hospital in New York's Mount Sinai Health System, described efforts to get faculty members and residents to eliminate the terms "gross" and "grossly" from reports. In a letter to staff, they explained that the terms have negative connotations and could be deemed offensive by a lay reader who saw something such as "no gross abnormality is detected in this patient." The researchers suggested alternatives including definite, obvious, conspicuous and convincing.

While compliance rates with the voluntary request were high, some resisted, including a few who continued to use the terms because they still thought gross and grossly were better terms, and others because those words were built into report templates the radiologists were accustomed to using. One commented, "I don't think the negative connotations of the word make it inappropriate to use and it is being used precisely."

To be sure, radiology reports still have to use clinical language and technical terminology, and "appropriate medical language or diagnoses should not be diluted or couched in euphemism," Dr. Bruno and colleagues acknowledged in their open letter to radiologists.

But at the same time, reports not only can be clearer but also can make patients feel better about themselves, the letter says. For instance, it suggests, if a patient has trouble undergoing a test, rather than stating that the "patient refused" to do something or citing "poor cooperation," reports can say the "patient was not able to" perform in some way or "expressed concern regarding" some aspect of the procedure—which is factually correct and nonjudgmental. Or, in more ways than one, nicely done.

Ms. Landro is an assistant managing editor for The Wall Street Journal in New York and writes the Informed Patient column. She can be reached at laura.landro@wsj.com.